Dysfonctionnement des voies urinaires inférieures dans la maladie de Chagas:présentation clinique et urodynamique

Lire l'article paru dans le World Journal of Urology (en anglais) fournit une description et une estimation de la prévalence des désordres urinaires dans la maladie de Chagas, quand la plupart des recherches cliniques sont centrées sur la description des formes cardiaques et digestives.

Abstract

Purpose

To describe and give an estimation of the prevalence of urinary disorders in chronic Chagas disease, since most clinical research has been centered on the description of the cardiac and digestive forms.

Methods

To explore this topic, a cross-sectional study was conducted in 137 Bolivian adults of both sexes suffering from symptomatic chronic Chagas disease. All patients presenting confirmed chagasic cardiomyopathy, megacolon or both underwent a urologic symptom questionnaire, uroflowmetry, urinary tract ultrasonography and a creatinine assay. When urinary abnormality was detected, a complete urodynamic study was proposed including cystometry, pressure-flow studies and urethral pressure profile.

Results

Out of all study patients, 35 (26%) had a Chagas cardiomyopathy, 81 (59%) a megacolon, and 21 (15%) a megacolon associated with cardiomyopathy. In all, 63% presented urinary disorders defined by IPSS > 7 and/or ICIQ SF > 1. Among them, 62% were incontinent, mainly by bladder overactivity, and 45% presented grade 2 or 3 renal insufficiency. Of 49 patients, the urodynamic study identified 34 patients with detrusor overactivity (69%), mostly in those with Chagas megacolon. Median bladder functional capacity, urethral closure pressure and bladder compliance had normal values. Moreover, 36% of these patients presented moderate hypocontractility, without significant post-void residual.

Conclusions

This study evidenced lower urinary tract dysfunction in a majority of chronic chagasic patients; those presenting megacolon were more likely to suffer from urinary incontinence. These results strongly suggest including routine urological clinical investigation in chronic Chagas patients, as urinary incontinence due to overactive bladder is frequently observed in this population.

Keywords

Chronic Chagas disease · Trypanosoma cruzi · Bladder · Neurogenic bladder · Lower urinary tract · Urodynamic

En savoir plus: https://doi.org/10.1007/s00345-018-2512-3 

Publiée : 11/10/2018

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